可溶性 ST2 水平可预测射频消融后长期心房颤动复发的风险。
The soluble ST2 level predicts risk of atrial fibrillation recurrences in long-term period after radiofrequency ablation.
机构信息
Tyumen Cardiology Research Center, Tomsk National Research Medical Center of the Russian Academy of Sciences, 111 Melnikaite Street, Tyumen, 625026, Russian Federation.
出版信息
BMC Cardiovasc Disord. 2024 Aug 28;24(1):460. doi: 10.1186/s12872-024-04119-z.
BACKGROUND AND OBJECTIVES
The hypothesis of the study was the assumption that the serum levels of soluble ST2 (sST2) and growth differentiation factor (GDF-15) can be predictors of atrial fibrillation (AF) recurrence in long-term period after primary radiofrequency catheter ablation (RFA).
METHODS
Of the 165 patients included in the prospective follow-up, the final analysis included 131 patients whose follow-up duration reached 18 months after the end of the blanking period (3 months after RFA). The median age of patients was 59.0 (50.0; 64.0) years, and 80 (61%) were men. Paroxysmal AF was present in 103 (79%) and persistent AF in 28 (21%) patients. All patients underwent transthoracic and transesophageal echocardiography, and electroanatomic mapping was used to assess the area of low-voltage zones (LVZ). sST2 and GDF-15 levels were determined by ELISA using GDF-15/MIC-1 analytical kits (BioVender, Czech Republic) and Presage ST2 (Critical Diagnostics, USA) before RFA. After RFA, patients had regular follow-up visits at 3-6-9-12-18 months with 12-lead ECG or Holter ECG monitoring and with clinical evaluation. The primary endpoint was the occurrence of the first symptomatic AF recurrence (AFr) lasting > 30 s, recorded on an ECG or during daily ECG monitoring, after a blanking period.
RESULTS
At the 18-month follow-up, 47 patients (35.9%) had AFr. The groups with and without AFr didnt differ in the LVZ area. The medians of NT-proBNP, GDF-15 and sST2 also didnt differ significantly between the groups, but in patients with AFr, the proportion of those with sST2 ≥ 36 ng/ml (the border of the lower and middle terziles) was higher (p = 0.03). According to the one-factor Cox regression analysis, AFr were associated with four factors: AF history ≥ 1 year, early AFr (during the blanking period), left atrial appendage flow velocity (LAAFV) < 54 cm/sec and sST2 ≥ 36 ng/ml. In the multivariate Cox analysis two independent predictors of AFr were obtained: sST2 ≥ 36 ng/ml (HR = 3.8; 95% CI 1.5-9.8, p = 0.006) and LAAFV < 54 сm/sec (HR = 1.96; 95% CI 1.01-3.82, p = 0.048).
CONCLUSIONS
Serum sST2 level with a cut-off value of 36 ng/ml or more can be used as a predictor of AF recurrence in the long-term period after primary RFA.
背景与目的
本研究的假设是，血清可溶性 ST2（sST2）和生长分化因子（GDF-15）水平可预测原发性射频导管消融（RFA）后长期心房颤动（AF）的复发。
方法
在 165 例前瞻性随访患者中，最终分析包括 131 例患者，其随访时间在空白期（RFA 后 3 个月）结束后达到 18 个月。患者中位年龄为 59.0（50.0；64.0）岁，80 例（61%）为男性。103 例（79%）为阵发性 AF，28 例（21%）为持续性 AF。所有患者均行经胸和经食管超声心动图检查，并用电极标测进行低电压区（LVZ）面积评估。在 RFA 前，使用 GDF-15/MIC-1 分析试剂盒（BioVender，捷克共和国）和 Presage ST2（Critical Diagnostics，美国）通过 ELISA 测定 sST2 和 GDF-15 水平。RFA 后，患者在 3-6-9-12-18 个月进行常规随访，采用 12 导联心电图或动态心电图监测和临床评估。主要终点是在空白期后记录到持续时间超过 30 秒的首次有症状 AF 复发（AFr）。
结果
在 18 个月的随访中，47 例患者（35.9%）发生 AFr。有和无 AFr 的组间 LVZ 面积无差异。NT-proBNP、GDF-15 和 sST2 的中位数在两组间也无显著差异，但 AFr 组 sST2≥36ng/ml（下中位数和中中位数的边界）的比例较高（p=0.03）。根据单因素 Cox 回归分析，AFr 与四个因素相关：AF 病史≥1 年、早期 AFr（在空白期内）、左心耳血流速度（LAAFV）<54cm/sec 和 sST2≥36ng/ml。在多因素 Cox 分析中，获得了两个独立的 AFr 预测因子：sST2≥36ng/ml（HR=3.8；95%CI 1.5-9.8，p=0.006）和 LAAFV<54cm/sec（HR=1.96；95%CI 1.01-3.82，p=0.048）。
结论
血清 sST2 水平≥36ng/ml 可作为预测原发性 RFA 后长期 AF 复发的指标。
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